Health­ier out­look

Con­sumers, pro­duc­ers keep­ing watch on calo­ries, says pre­lim­i­nary re­search

Modern Healthcare - - THE WEEK IN HEALTHCARE - Paul Barr

There are signs that Amer­i­cans are paying closer at­ten­tion to eat­ing health­ier and that food pro­duc­ers and restau­rants are mak­ing it eas­ier to do so. Progress is coming on both the pro­ducer and con­sumer side of the equa­tion. A num­ber of cor­po­rate part­ner­ships are set­ting con­crete goals for mak­ing food health­ier. The ef­forts of­ten team pub­lic and pri­vate en­ti­ties and go by such names as the Healthy Weight Com­mit­ment Foun­da­tion and the Na­tional Salt Re­duc­tion Ini­tia­tive.

At the same time, the num­ber of calo­ries peo­ple are con­sum­ing ap­pears to be lev­el­ing off.

But be­fore con­clu­sions are drawn about whether the coun­try is really eat­ing health­ier, re­searchers need to mea­sure whether those cor­po­rate ini­tia­tives are de­liv­er­ing what they prom­ise and iden­tify what is driv­ing the lower calo­rie con­sump­tion. The an­swers are crit­i­cal as poor di­ets con­trib­ute to alarming rises in chronic and acute ill­nesses, and some re­searchers ques­tion whether large food cor­po­ra­tions should be trusted to be part of the so­lu­tion.

“Calo­ries are drop­ping sig­nif­i­cantly,” said Meghan Slin­ing, re­search as­sis­tant pro­fes­sor at the Univer­sity of North Carolina at Chapel Hill, Gillings School of Global Pub­lic Health.

Pre­lim­i­nary re­search in­di­cates that daily per-capita en­ergy in­take among U.S. chil­dren and ado­les­cents in­creased con­sid­er­ably from 1989 to 2004, and then fell through 20092010, Slin­ing said.

But a num­ber of things could be caus­ing that drop. One could be the ef­forts by com­pa­nies to make food health­ier. Or it could be that bet­ter pub­lic aware­ness of the dan­gers of un­healthy food and the re­cent eco­nomic slow­down have led peo­ple to make dif­fer­ent food choices, Slin­ing said.

And the coun­try has a long way to go be­fore its res­i­dents could be con­sid­ered healthy eaters. “We’re see­ing some pos­i­tive changes. It’s still not close to what it should be,” she said. She noted, for in­stance, that calo­ries con­sumed by chil­dren in low-in­come fam­i­lies re­mained higher in 2009-2010 than in 1989-1991.

Slin­ing is one of the re­searchers work­ing to de­ter­mine if the cor­po­rate pledges of 16 mem­bers of the Healthy Weight Com­mit­ment Foun­da­tion are hav­ing any ef­fect. In a study funded by the Robert Wood John­son Foun­da­tion, she and her col­leagues are assess­ing the success of a group of com­pa­nies that col­lec­tively pledged to re­move 1 tril­lion calo­ries from the mar­ket­place by 2012 and 1.5 tril­lion by 2015. The par­tic­i­pants in­clude Coca-Cola Co., Kraft and Nes­tle.

The re­searchers just re­leased a base­line es­ti­mate for the num­ber of calo­ries con­sumed in 2007 in pack­aged foods and drinks from the 16 com­pa­nies, coming up with a num­ber of 67.3 tril­lion calo­ries, which rep­re­sents about 36% of such calo­ries con­sumed. That num­ber will be used to cal­cu­late whether or not the com­pa­nies were able to com­plete their pledge. The base­line report was pub­lished in the Fe­bru­ary is­sue of the Amer­i­can Jour­nal of Pre­ven­tive Medicine.

The hope is that the study will spawn sim­i­lar ef­forts that will feed the hunger for data on food con­sump­tion. That way, when groups such as the Na­tional Salt Ini­tia­tive an­nounce success in re­duc­ing salt con­sump­tion—as it did last week—there will be tools to an­a­lyze such claims. The salt ini­tia­tive has a num­ber of goals, with com­pa­nies such as Kraft claim­ing success in re­duc­ing sodium across its port­fo­lio by an av­er­age of 10% over three years.

But an­other group of re­searchers from Aus­tralia re­ject the part­ner­ship model, ar­gu­ing that pub­lic-pri­vate ef­forts are a means to de­lay or pre­vent greater reg­u­la­tion of the food in­dus­try. In a report pub­lished on­line last

week by the Lancet, the au­thors wrote that “there is lit­tle ob­jec­tive ev­i­dence that pub­licpri­vate part­ner­ships de­liver health ben­e­fits and many in the pub­lic health field ar­gue that they are just a de­lay­ing tac­tic of the un­healthy com­mod­ity in­dus­tries.”

The au­thors ar­gue that reg­u­la­tion is the best so­lu­tion to the prob­lem of com­pa­nies sell­ing un­healthy foods.

Pub­lic health of­fi­cials from ma­jor met­ro­pol­i­tan ar­eas that in­clude Seat­tle, Los An­ge­les and Bos­ton joined the Cen­ter for Sci­ence in the Pub­lic In­ter­est in a let­ter last week ask­ing the Food and Drug Ad­min­is­tra­tion to reg­u­late the amount of sugar and corn sweet­en­ers in bev­er­ages.

But reg­u­la­tion isn’t a real­is­tic op­tion in the U.S., said Bill Di­etz, who in June left his post as di­rec­tor of the di­vi­sion of nutri­tion, phys­i­cal ac­tiv­ity and obe­sity at the Cen­ters for Disease Con­trol and Preven­tion. “Given the split in Congress it’s un­likely we’re go­ing to get a reg­u­la­tory an­swer or strat­egy on this,” he said.

Di­etz also said there are com­pa­nies that are sin­cere about their ef­forts to pro­duce health­ier food. But some big ob­sta­cles re­main in the way of get­ting com­pa­nies to do that, and one is that the ma­jor in­gre­di­ents caus­ing health prob­lems—fat, salt and sugar—are what makes food taste good. Com­pa­nies have to be given an in­cen­tive to sell health­ier food, Di­etz said.

That was the thrust of a report from the not-for-profit Hud­son In­sti­tute ear­lier this month, also backed by Robert Wood John­son. Restau­rant chains sell­ing lower calo­rie foods did bet­ter in terms of sales and cus­tomer traf­fic, the report con­cluded. The au­thors want the re­sults to spur the chains to fo­cus more on health­ier menus.

And Slin­ing said the pub­lic-pri­vate ef­forts should not be dis­counted. They are nat­u­ral ex­per­i­ments that can help the ef­fort to get health­ier foods on ta­bles across the coun­try, even if they are shown to be un­suc­cess­ful. “Some­thing is hap­pen­ing, and we can ob­serve if it makes a dif­fer­ence or not,” she said.

AP PHOTO

Coca-Cola’s C2 is a new re­duced-sugar prod­uct mar­keted to peo­ple look­ing for a lower calo­rie and re­duced-carb bev­er­age.

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